Before Surgery

FIRST – REVIEW THE BASICS

The larynx is the second most common site for cancer development in the upper aerodigestive tract. Approximately 12,500 cases are diagnosed each year.  Over 95% of the cancers that develop in the larynx are of the squamous cell carcinoma (SCCA) variety.  Deaths from larynx cancer represent only 1% of all cancer-related deaths each year. The overall 5-year survivor rate for larynx cancer is about 68%.  The most vulnerable “population” for this disease is males in their 50’s and 60’s … less than 1% of cases are in people less than 30 years old.  Smoking is one causative factor – smoking 1/2 pack a day increases the likelihood of getting larynx cancer by about 4 times “normal”; smoking 2 packs a day ups your chances to about 10 times “normal”.  For T1 tumors, XRT (radiation) treatment enjoys about a 90% cure rate; for T2 tumors, XRT treatment boasts about a 70% success rate.  Surgery (total laryngectomy), however, for T1 and T2 tumors boasts success rates of 98% and 82% respectively.  For the more advanced stages of tumors (T3 and T4), surgery is roughly 80% successful while XRT treatment is only about 50% successful.  Therefore, if you have symptoms, your best hope is early diagnosis and treatment!!

Message to A New Laryngectomee, or Laryngectomee-to-be:

Despite all of the medical progress made, the word “cancer” is still pretty frightening. But having dealt with radiation and then the surgical removal of my larynx, I think that some of the most important things I would want to say to a new laryngectomee (or someone about to become a laryngectomee)are:

1.This is NOT the end of the world. Cancer of the larynx has one of the highest cure rates for any cancer. The odds are WAY in your favor that this cancer will be removed, will not return, and you will live.

2. You will almost certainly speak again, although the specific means you will use may not be known right from the beginning. One irony is that many laryngectomees can speak in several different ways. For example, before the cancer we could speak using our larynx. Now many of us have more than one way to speak such as using an artificial larynx plus one of the esophageal speech methods.

3. Not only can you survive this, you can also “thrive.” Although I certainly had fears about whether I could or not, I returned to my full-time job as a teacher, and I know lots of laryngectomees who work at jobs requiring that they speak including lawyers, preachers, auctioneers, a radio DJ, sales personnel, an active duty police officer, other teachers, musicians, etc.

4. While I certainly miss my old vocal cords I do not consider myself to be “handicapped”. I think the word”inconvenienced” sums up how I feel now. I have a few more daily maintenance jobs to add to showering, shaving and brushing my teeth; but that is basically it. I also have a couple of additional things to remember to bring with me when I leave the house besides my wallet and keys.

5. It helped me so much to talk with other laryngectomees before the surgery and afterwards. I am also so glad that there was a local laryngectomee support group I could join, and I also joined the WebWhispers Internet support group.
It is helpful to know that you are not alone, that others have faced what you are facing and can help you through it, and provide you with living examples of how you can successfully survive all of this and move on to a full life.
The Webwhispers website is crammed with helpful information for the laryngectomee and his/her family. Your community may have a local support group. Check the WW site and the International Association of Laryngectomees (theIAL.com) site to see if you have one.

6. Physical healing takes time. Healing from a laryngectomy is not measured in days or weeks, but in months and even years. So do not assume that the problems you have early on after the operation will continue. You will get better and better; but gradually. It is fairly typical to also “mourn” the loss of our voices, and it takes awhile to get over the trauma of all of this.
And mourning is perfectly ok, it is also part of the healing process. You might need some professional help to deal with the understandable depression this may cause. But do know that there is life, and a full one, on the other side of this healing process.

7.Families of those facing cancer also can suffer and require counseling help.

8.If you work and can do so, try and retain your rights to return to your job after you have healed. Many employers will be ignorant about cancer survival and assume you will not be able to do whatever the job requires. And you may be pressured to resign or retire early. If possible, avoid making any option-ending decision at a time when you are stressed and vulnerable. You may have to educate your employer on what a laryngectomee can still do.

9. Excellent information is available to you on all aspects of larynx cancer, treatments and rehabilitation at: http://www.cancer.org
I am 95% the same as before my cancer. The 5% is really no big deal now unless I focus on that instead of the 95%. Part of the healing process involves an improvement to that 5%, but also changing your focus back to what you do have and can still do. There are actually several advantages to being a lary. Just a couple are that it is now impossible for you to choke on food, or to snore, and most of us have fewer problems with allergies or colds since we no longer breathe through our noses. Since cancer kills so many people I am grateful for every day I have. I feel like I have cheated death and have been given a second chance at life, even though there was a price to pay for it. Best wishes to you. If you are fortunate, you will get the support of good professional help and other laryngectomees who have traveled the path you are on. Please feel free to ask any question you have.

And having an arm or two to grab hold of while we travel in unfamiliar territory is a big comfort. Regards, :)o

David Blevins
Posted: 07/18

Total VS Partial Laryngectomy

Total Laryngectomy vsPartial Laryngectomy: What to Expect After SurgeryTotal LaryngectomyA total Laryngectomy (TL) is a surgical procedure in which the aerodigestive tract is surgically altered separating the trachea from the esophagus due to invasive laryngeal and hypopharyngeal cancers. A total laryngectomy is complete removal of the larynx (voice box) which is the entrance to the airway and affects breathing and speaking. Once an individual has undergone a TL, the ability to speak will be gone. The nose and mouth will no longer perform the functions they once had which is to filter and warm the air that we inhale/exhale, because these structures are disconnected from the trachea. The individual will now have a hole in the neck called a stoma, which is the new pathway for breathing. Impact on Voice and Voicing Options After TLBecause a TL is complete removal of the larynx, which removes the entirety of the vocal cords, the ability to speak naturally is gone; however, there are alaryngeal options to produce voice and communicate, including: tracheoesophageal puncture, electrolarynx device use, esophageal speech, and alternative and augmentative communication. The following is a brief overview of these various options. TEP: TEP stands for tracheoesophageal puncture. This is a small hole, or fistula, that is surgically created through the common party wall of tissue between the trachea and the esophagus. This is performed during a TL as a “primary puncure”, or later on as a “secondary puncture.” A prosthesis fits into that opening to prevent food/liquid from going into the lungs. Upon inspiration, the patient will occlude the stoma to force exhaled air through to the esophagus where the tissues will vibrate and create sound. A TEP may or may not be covered by your insurance and requires routine maintenance and replacement of the voice prosthesis on an ongoing basis. Electrolarynx: An electrolarynx is a battery-operated device that produces sound to help create a voice. When the button is pushed on the device, it produces a vibration which is transferred from the skin to the mouth. Words are shaped with the articulators (lips, teeth, and mouth). The device can be placed in multiple areas to achieve alaryngeal voicing (cheek placement, neck placement, or inside the mouth using an adaptor). Esophageal Speech: This method of speech uses the esophagus as a source of sound for speech, which involves trapping small amounts of air into the esophagus and allowing that air back up and out the mouth. The vibratory source for sound is, as in the TEP, the esophagus. This method requires no external devices or equipment; in many cases it does involve a significant amount of practice to achieve mastery AAC: This stands for alternative and augmentative communication. Persons with TL may prefer to use high tech communication devices (text to speech apps, and boogie boards), or low-tech communication (white boards, communication boards).Swallowing After TLPrior to TL surgery, there is an extreme likelihood that a person may have had decreased airway protection from the invasive laryngeal cancer, thus resulting in dysphagia (difficulty swallowing). Immediately after a TL, the patient will not be able to eat by mouth for a couple of weeks, depending on the surgeon’s recommendations. The patient will likely have a PEG tube for alternate means of nutrition after surgery. Most of the time, swallow function will improve and the patient will be able to eat and drink. Swallowing difficulty is more likely if the patient has had previous chemoradiation of the head and neck, TEP malfunctions (leaking TEP), or esophageal disruptions. Partial LaryngectomyA partial laryngectomy is partial removal of the larynx due to cancer and is usually done if cancer or a lesion is found at an earlier stage. There are multiple different types of partial laryngectomies, which change the patient’s anatomy/physiology in a variety of ways. This can subsequently affect voicing and swallowing in different ways depending on the surgery. Recurrence of cancer is possible with this type of surgery. Types of Partial Laryngectomies• Cordectomy: Removal of the vocal cords. • Frontolateral Laryngectomy: Cutting of the vocal cords, and the front third of the arytenoid cartilage.• Hemilaryngectomy: Removal of the vocal cords, thyroid wing, and arytenoid cartilage.• Supraglottic laryngectomy: Removal of the structures between the glottis and base of tongue (above the vocal cords).• Cricohyoid epiglottopexy (reconstructive surgery): Removal of the vocal cords, thyroid cartilage, and optionally the epiglottis.• “Three quarters” laryngectomy (near-total): hemilaryngectomy and supraglottic laryngectomy. Voicing after Partial LaryngectomyA partial laryngectomy surgery to remove near, part, or all of the vocal cords may have an impact of voicing. Vocal function will be altered depending on the type of surgery. If the patient has a supraglottic laryngectomy (above the vocal cords), voicing will likely be unchanged because the vocal cords are not damaged. With cordectomy, frontolateral laryngectomy, and hemilaryngectomy the voice is usually weak/breathy and may require alternative means of communication (such as AAC devices discussed above), because there has been partial removal of the vocal cords. Swallowing after Partial LaryngectomyThe larynx plays a major part in swallowing function. Prior to a laryngectomy, the airway and upper digestive tract are connected. During the swallowing, the airway is protected by larynx as it elevates and the vocal cords close, and food and liquid are then directed down the esophagus toward the stomach. Partial laryngectomy may impact swallowing function, since the larynx is being anatomically altered, thus decreasing airway protection. Depending on the type of partial laryngectomy, swallowing function will vary from patient to patient. A patient with a partial laryngectomy may need to consider a modified diet or alternate means of nutrition/hydration/medication, such as via a PEG tube. Lacey Trevisani, MS, CF-SLPSpeech-Language PathologistLtrevisani@tgh.orgLacey Trevisani, MS, CF-SLP is the current clinical fellow at Tampa General Hospital with an area of special interest in the evaluation and treatment of patients with head and neck cancer with a focus on alaryngeal voice restoration following total laryngectomy and dysphagia management. Lacey completed her undergraduate degree at the University of Florida majoring in Communication Sciences and Disorders and completed her graduate degree at The University of South Florida in Speech-language Pathology. After completion of the clinical fellowship year, Lacey hopes to attain a position as a certified Speech-language Pathologist within the acute care setting with a continued focus in the area of head/neck cancer. Tampa General Hospital1 Tampa General Circle Tampa, FL 33606 Office phone: (813)-844-7902For Further Reference: https://webwhispers.org/resource/talking-again/https://webwhispers.org/resource/free-for-the-asking/#toc-5www.atosmedical.com “Laryngectomy Care/Photos- Manufacturer of Provox System.” https://inhealth.com/media/documents/pdf/LT_ANATOMICAL_AID-B_ENG_WEB(1).pdf

Cancer Hope Network

They match a survivor with the patient. They match as close as possible, using same sex, age, treatments, etc. Before being matched the volunteer is trained
CancerHopeNetwork.org

CONTACT OTHER LARYNGECTOMEES

Contact the IAL (International Association Of Laryngectomees) or your local ACS (American Cancer Society) to put you in touch with other laryngectomees. Usually your doctor can provide you with the information on how to contact the nearest group in your area. Even if you are not normally a joiner of support groups, you should investigate your local support group for laryngectomees, often called Lost Chord or NuVoice clubs. Some of them provide free materials or can tell you where to apply for whatever equipment or rehabilitation benefits might be available in your area.. Clubs like this frequently get discounted or even free samples from suppliers. However, the most important part of going to a club is the assistance you receive from members who can answer questions, help you learn to talk and assist with other problems. You can find a listing on our site of USA clubs at https://www.theial.com/united-states-club-search .  The IAL has an international list at: https://www.theial.com/international-club-search1

GET ONLINE

Join WebWhispers if you have not already become a member. Go to the upper right of the home page to join.

This site has many pages of helpful information, plus sections with Hints, Suppliers, and Humor. Laryngectomees, caretakers, and professionals can meet on an e-mail list to exchange messages, ideas and support. It is free to join and no dues to pay. We operate on donations only.

American Cancer Society (Home Page)

A current report on Laryngeal and Hypopharyngeal Cancers covering what they are, diagnoses, staging, statistics, treatments, and follow up care. There is also a section on what is new in research and treatment.

International Association of Laryngectomees

This site has all of the current information on the IAL, helpful information, plus newsletters, and local club listings. They can be accessed at theial.com

INFORMATION – EDUCATE YOURSELF

The IAL has publications that are sent out free of charge. These include:

Pocket Emergency Cards

Emergency cards are available in English and Spanish. (Send stamped self addressed envelope and specify language.)

Emergency Window Stickers

These emergency stickers can be used on automobiles or on home windows. They are available in English and Spanish. (Send stamped self addressed envelope and specify language.)

First Steps

First steps is a document to help new laryngectomies to learn the basics.

IAL Brochure

Information about the IAL.

The IAL News

A newsletter that is published 3 times a year. A $5 a year donation is requested but not necessary.

Building A Successful Laryngectomee Club

Information on how to start a club or make your club successful.

Laryngectomee Visitor Program Manual

A training manual for those that want to make Pre or Post Operation visits to new laryngectomees.

Rescue Breathing for Laryngectomees and other Neck Breathers

Available in English and Spanish.

The above can be obtained from:
The IAL
925B Peachtree Street. NE, Suite 316
Atlanta, GA 30309

Talking to Children about Cancer

Patient Resources Magazine is very good. The following article has some good advice about discussing cancer with children.
https://www.patientresource.com/Kids.aspx

SUPPLIERS

Call some of the laryngectomy/medical suppliers, and request their catalogs ahead of time. You may want to pre-purchase a shower collar and some stoma covers or foam filters. Find out what your doctor recommends and what he will furnish so you don’t duplicate. Most hospitals send you home with immediate needs. Look under Suppliers for a list of suppliers.

COMMUNICATION WITHOUT A VOICE

One of the things you need to learn is the sign language for Help Me in case you need help and can not communicate.

Call Inhealth Technologies at 1-800-477-5969 and ask them to send you their free Laryngectomy Needs Chart. This chart is useful during your hospital stay, as well as at home following your discharge. A dry erase marker can be used to add your own additional personal needs to it.

Obtain either a Magic Slate (one of the boards that kids write on and pull up the plastic sheet to erase) or buy a Magna Doodle, available in most toy stores. A pencil shaped magnet is used on the Magna Doodle “screen” to write. A pull knob on the bottom erases it. They come in three sizes. Get the medium or largest size. Another option is a Boogie Board. It is similar to the kids version but is electronic and erases with a button. The can be purchased off many locations including Amazon.com.

Some people recommend obtaining an Electrolarynx before surgery. Please see the Electrolarynx Hint under Post Laryngectomy section.

MAKE RECORDINGS

It is especially important if you live alone to make a recording for your answering machine. You might want to purchase an inexpensive recorder and make several, since one can be erased in error. You may also make a message for emergency needs to play after dialing 911 although you should notify 911 that a laryngectomee is going to be living at your address and they will mark your record to check any call from your house. (Katy Lyons)

DOCTOR VISITS

Familiarize yourself with how being a laryngectomee changes your anatomy so you will understand how everything works after surgery and understand what your doctor tells you. Jot down all questions you may have for your doctors. Bring this list of questions along for appointments. Remember that no question you have is silly or unfounded. Knowledge is Power!! Get copies of your records as you go along, and keep them in a folder at home. This can save a lot of time and stress if you need them for anything later on.  Please make an effort to become familiar with all the information available on our General Information page.

CHILDREN

If you have children or grandchildren, take the time to explain to them as best you can about what is about to take place, and the changes that will occur. Young children should not be given complicated explanations. For older children, share your books and suitable videos. Let’s not forget that our children can be just as anxious and fearful as we are at this time. However, little children adapt to the new laryngectomee unbelievably fast and usually want to try out the electrolarynx. Some toddlers find toys to put up to their necks so they can pretend to talk like their loved one.